Artificial intrauterine insemination or IUI is the simplest and least invasive fertility treatment available. There are different IUI methods according to the source of the sperm (male partner or a donor). The procedure is the same for both methods, although the type of cycle used (natural or stimulated) can vary depending on the cause of infertility and the results of previous attempts.
The first fertility treatment option for heterosexual couples is usually IUI with the sperm of the male partner. In this case, the man will need to provide a sperm sample in the collection container provided by masturbation. This usually takes place in a collection room at the fertility clinic at the same day the IUI procedure is scheduled.
For performing this IUI method, the sperm will be washed and prepared in the andrology laboratory to get a concentrated sample of healthy sperm, which will be directly introduced in the uterus of the woman. The sperm specimen used for the IUI can be a fresh or a frozen sample. Frozen samples have the same success rates as a fresh sample but allow for convenient scheduling if the male partner is not available to provide a fresh specimen on the day of the insemination. Sperm that was previously frozen is thawed and prepared on the day of the IUI.
The first treatment option for single women and female homosexual couples is IUI with the sperm of a donor. It is also a common IUI method for heterosexual couples who cannot use their own sperm to have a child due to severe male infertility.
Whether the donated sample comes from someone known or from a sperm bank, it is screened for infections and inherited diseases before it can be used. As some infections such as HIV take some time to be detectable in blood since being contracted, the sperm needs to be frozen for at least six months so that the donor can undergo a second blood test to confirm that the sperm is free from infection. Only then the frozen sample can be used.
In this case, the frozen donor sperm will be thawed and prepared the same day the IUI treatment has been scheduled.
In young women with regular cycles, normal ovulation and a good ovarian reserve, IUI can be performed in a natural cycle, without administering any fertility drugs. To increase success chances, follicle maturation can be monitored by blood tests and ultrasound, and the insemination procedure is scheduled just before ovulation, which usually happens between 12 and 16 days after the last period in women with regular menstrual cycles.
Generally, fertility drugs are used to stimulate follicular maturation and ovulation before IUI. In this case, follicular development needs to be monitored by ultrasound, to determine the number of growing follicles and their maturity state, and blood levels of estradiol, LH and progesterone can be measured to give supplementary information about the cycle. Once one or two eggs are mature enough, ovulation is triggered by a hormone injection and the IUI procedure will be performed approximately 36 hours after.
However, if more than two follicles have grown and are reaching maturity, the IUI cycle may be cancelled to avoid a multiple pregnancy (twins, triplets or more babies). In this case, if a heterosexual couple is undergoing the treatment, the doctor will ask them to abstain from sexual intercourse to avoid a natural multiple pregnancy.
The day of the IUI procedure, the woman will lie down on a gynaecological table in the consultation room and a speculum will be inserted to visualize the cervix. The catheter with the processed sperm sample is then placed into the womb.
The insemination itself is mostly painless, although some women experience mild cramping for a short while. It usually takes no more than 10 minutes and after a short rest period the woman can go home and continue normally with her daily activities.
The doctor may prescribe vaginal progesterone to support the endometrial changes needed for implantation. About 14 days after the IUI the woman may undergo a pregnancy blood or urine test to see if the procedure has been successful. It is important to remember this type of fertility takes time to be successful. On average a women may have to undergo 4-6 inseminations depending upon her age before becoming pregnant. It’s important to discuss your specific case with your fertility doctor to confirm inseminations is the right treatment choice for you.